Neurocysticercosis: a review

An Interesting Case Report on a Myocysticercosis Cyst

One of the most dangerous parasite infections, cysticercosis, is found practically everywhere in the world. Cysticercus cellulosae is the larval stage of the swine tapeworm Taenia solium, which causes cysticercosis. Orbital or ocular cysticercosis (OOC) is an avoidable cause of blindness. There are two types of ocular cysticercosis: intraocular (in the anterior chamber, subretinal space, or vitreous) and extraocular (in the orbital tissues or subconjunctival space). Here, we report a rare case of extraocular muscle cysticercosis that presented as a solitary, well-defined lobulated mass near the medial canthus in the right eye and was well managed medically with antihelminthic drugs and corticosteroid therapy. The key to diagnosing myocysticercosis is orbital imaging. Although brain and ocular involvement in cysticercosis is common, extraocular muscle cysticercosis is extremely uncommon and mainly affects young people and children. Orbital pseudotumor, idiopathic myositis, and hydatid cysts are a few differential diagnoses for ocular cysticercosis. It is critical to recognize and treat such illnesses as early as feasible to avoid serious consequences. Public health measures are essential to eradicate this disease in the area.

Neurocysticercosis Diagnosis in a Non-Endemic Country: France

Diagnosing neurocysticercosis (NCC) is difficult due to its variable clinical presentations and the different imaging techniques used to detect brain damage. This study aimed to evaluate the use of cerebrospinal fluid serology and PCR for diagnosing biological neurocysticercosis in a non-endemic country. We tested samples from patients living in France with suspected NCC and confirmed that 45 of the patients presented with the disease. A total of 89% of patients had previously traveled to countries where the disease was endemic. The sensitivity of Western blots compared to ELISA was not significantly different (80% vs. 60%) (p > 0.05), and neither was the sensitivity of Western blots vs. PCR (78% vs. 56%) (p > 0.05). The PCR sensitivity was 78% and 47% in definitive NCC and in probable NCC. PCR tests using cerebrospinal fluid should be considered as a diagnostic criterion for identifying NCC.

Optical Coherence Tomography Features of Ocular Cysticercosis: A Review of Literature With Observer Variation

Ocular cysticercosis is a sparsely reported condition, requiring urgent management. The gold standard for diagnosis is an in toto extraction of the cyst with subsequent histopathology. The procedure can be demanding in contrast to the frequently adopted practice of in vivo cyst lysis. The latter, however, obviates a conventional biopsy. We reviewed published optical coherence tomography (OCT) images of ocular cysticercosis for their suitability to surrogate a conventional biopsy and identified commonly reported features. We also used triple masking and ascertained the observer agreement on identification of these features. We found that the features of the parasite are much more clearly discernible as compared with features of the involved ocular tissue itself. The hyperreflective cyst wall and scolex and the hyporeflective cyst cavity had the highest frequency and observer agreement among all the analyzed features, suggesting their use for diagnosis. We could match many of the OCT features with the previously reported histopathological findings, supporting the role of OCT as a diagnostic adjunct and a substitute for conventional biopsy. Conversely, features of the ocular tissue could be judged poorly with low observer agreement, suggesting poor prognostic ability of OCT. [Ophthalmic Surg Lasers Imaging Retina 2022;53:446-454.].

Microsurgical Treatment of Epilepsy with Parenchymal Neurocysticercosis

Parenchymal neurocysticercosis is the most common form of neurocysticercosis in the central nervous system (CNS), which mainly causes epilepsy and usually responses well to routine medications. However, there are appreciable cases of relapses refractory to medical treatment. We investigated microsurgical treatment of epilepsy with parenchymal neurocysticercosis. Nine cases of epilepsy caused by parenchymal neurocysticercosis from 2002 to 2018 were analyzed retrospectively. Cysts in 7 cases were completely removed. No case died of operation and no new dysfunction of the nervous system was observed after surgery. Among the other 9 cases, 8 cases became seizure-free or controlled by medicine according to the postoperative follow-up for 6 months to 9 years. One case was lost for follow-up. It was suggested that epilepsy with parenchymal neurocysticercosis can usually be controlled after routine medications. However, surgery is still indicated in some cases and careful microsurgery is associated with satisfactory clinical outcomes in appropriately selected cases.

Glycans in the roles of parasitological diagnosis and host-parasite interplay

The investigation of the glycan repertoire of several organisms has revealed a wide variation in terms of structures and abundance of glycan moieties. Among the parasites, it is possible to observe different sets of glycoconjugates across taxa and developmental stages within a species. The presence of distinct glycoconjugates throughout the life cycle of a parasite could relate to the ability of that organism to adapt and survive in different hosts and environments. Carbohydrates on the surface, and in excretory-secretory products of parasites, play essential roles in host-parasite interactions. Carbohydrate portions of complex molecules of parasites stimulate and modulate host immune responses, mainly through interactions with specific receptors on the surface of dendritic cells, leading to the generation of a pattern of response that may benefit parasite survival. Available data reviewed here also show the frequent aspect of parasite immunomodulation of mammalian responses through specific glycan interactions, which ultimately makes these molecules promising in the fields of diagnostics and vaccinology.

Treatment of racemose neurocysticercosis

Background:

Neurocysticercosis (NCC) is a common parasitic infection of the central nervous system, caused by the tapeworm Taenia solium. It is endemic to certain parts of the world, including Central America, South America, Asia, and Africa. The racemose form, characterized by extraparenchymal location, increased morbidity and mortality, and large loculated cystic lesions, is rarely seen in industrialized countries, such as the United States. The management of racemose neurocysticercosis (RNCC) differs from that of the typical parenchymal variant. The ideal course of treatment is debated by experts, but typically includes either surgical intervention with subsequent medical therapy or medical therapy alone.

Case Description:

We present the case of a 34-year-old male diagnosed with RNCC and treated successfully with surgical cyst drainage, resection, and subsequent medical therapy.

Conclusion:

Currently, no standardized evidence-based protocol exists that dictate appropriate treatment for extraparenchymal or racemose NCC. We present a case of RNCC treated successfully with surgical and medical intervention. Further research encompassing well-designed clinical trials is necessary to delineate appropriate and standardized protocols for treatment of this disease.

[Racemose neurocysticercosis: Neuroimaging guides the diagnosis]

Neurocysticercosis is the leading cause of parasitosis of the central nervous system and acquired epilepsy in developing countries. The clinical manifestations of neurocysticercosis, especially its racemose variant, are pleomorphic and unspecific, characteristics that hinder the diagnosis and make it a challenge for the clinician.The objective of this report was to describe two cases of racemose neurocysticercosis in which neuroimaging led to the definitive diagnosis. The first case involved a patient with persistent headache and focal neurological signs. She required multiple paraclinical tests that led to the definitive diagnosis of racemose neurocysticercosis with secondary cerebral vasculitis. Despite medical and surgical treatment the patient died after multiple complications.The second case involved a patient with a history of neurocysticercosis, who consulted for chronic intractable vomiting. She required multiple paraclinical tests that led to the diagnosis of vomiting of central origin secondary to racemose neurocysticercosis and entrapment of the fourth ventricle. After medical and surgical treatment the patient showed slight improvement. In these two cases it was evident how proper interpretation of neuroimages is essential for the diagnosis of racemose neurocysticercosis.

A Classic Case of Subcutaneous Cysticercosis: A Rare Case with Sonological Findings and Review of Literature

Background

Cysticercosis is a parasitic infection caused by the larval stages of the pork tapeworm, Taenia solium. The subcutaneous form of the disease is a relatively rare clinical entity. Despite its rarity, it is imperative for a radiologist to be aware of this subcutaneous form of the disease and its various radiological patterns while evaluating any subcutaneous swelling. In this paper, we aimed to describe a typical case of ‘subcutaneous cysticercosis involving the left anterior chest wall’ with high resolution ultrasound findings. We also discussed the role of other imaging modalities in a case of subcutaneous cysticercosis. To the best of our knowledge, our case is only the second documented case report of sonological evaluation of subcutaneous cysticercosis involving the left anterior chest wall and the first case with high resolution ultrasound images of the lesion.

Case Report

An 11-year-old male presented with a painless, subcutaneous swelling over the left anterior chest wall for the last 2 months. High resolution ultrasound showed a well-defined, thin-walled, cystic lesion with an eccentric, echogenic focus in the subcutaneous plane. On change of the posture of the patient, this focus showed mobility. The hypoechoic area surrounding this cyst showed significant exudative fluid collection with diffuse, floating echoes and thin, incomplete internal septations. The adjacent soft tissues were thickened and irregular, suggestive of edema. This was followed by an excision biopsy. Histopathological examination revealed cysticercus cellulose parasite with an extensive mixed inflammatory cell infiltrate in the surrounding tissue. The patient was also administered oral antihelminthic therapy. Repeat ultrasound examination at the end of this management regimen showed complete healing with no e/o any remnant or recurrent cystic lesion, abscess or edema in the subcutaneous plane.

Conclusions

Subcutaneous cysticercosis is a relatively rare form of cysticercosis but should always be born in mind during the evaluation of subcutaneous swellings. High resolution ultrasound is a valuable, safe, nonionizing, cost-effective, widely-available, and easily-reproducible imaging tool for diagnosis of subcutaneous cysticercosis. There is a wide spectrum of ultrasound patterns of subcutaneous cysticercosis. In classic cases with a cyst containing a scolex within and with a surrounding abscess, high resolution ultrasound should always be the primary mode of diagnosis, thus avoiding unnecessary fine needle aspiration cytologies.

Comparative genomics reveals adaptive evolution of Asian tapeworm in switching to a new intermediate host

Taenia saginata, Taenia solium and Taenia asiatica (beef, pork and Asian tapeworms, respectively) are parasitic flatworms of major public health and food safety importance. Among them, T. asiatica is a newly recognized species that split from T. saginata via an intermediate host switch ∼1.14 Myr ago. Here we report the 169- and 168-Mb draft genomes of T. saginata and T. asiatica. Comparative analysis reveals that high rates of gene duplications and functional diversifications might have partially driven the divergence between T. asiatica and T. saginata. We observe accelerated evolutionary rates, adaptive evolutions in homeostasis regulation, tegument maintenance and lipid uptakes, and differential/specialized gene family expansions in T. asiatica that may favour its hepatotropism in the new intermediate host. We also identify potential targets for developing diagnostic or intervention tools against human tapeworms. These data provide new insights into the evolution of Taenia parasites, particularly the recent speciation of T. asiatica.

Only one of the three Taenia species causing taeniasis in humans was previously sequenced. Here the authors provide draft genomes of Taenia saginata and Taenia asiatica, analyse genome evolution of all three species, and identify potential targets for developing diagnostic markers or intervention tools.

Ischaemic stroke induced by neurocysticerosis, presenting as a clinical and radiological dilemma

Neurocysticercosis (NCC) is a central nervous system parasitic infection with various clinical presentations, rarely manifesting as an acute stroke. The radiological appearance of this disease entity may be non-specific, at times mimicking an intracranial neoplasm. Early diagnosis requires a high index of suspicion. Serological testing is helpful and, if utilized early, can reduce the morbidity associated with invasive diagnostic techniques. We describe a case of a 32-year-old previously healthy male who presented with neurological deficits. A cystic lesion in the right sylvian cistern was noted, initially identified as a benign arachnoid cyst. The patient's symptoms rapidly progressed to an acute stroke. Follow-up imaging including an MRI of the brain demonstrated a right middle cerebral artery territory infarct adjacent to the cystic lesion, which had been diagnosed as an arachnoid cyst on an initial CT scan. Appearance of the cystic lesion on MRI, however, was concerning for a brain neoplasm or an abscess. Given the contiguity of the cystic mass to the right middle cerebral artery, it was suggested that the mass was the likely aetiology of the patient's symptoms. A stereotactic biopsy of the cystic lesion was performed and revealed it to be NCC. The hospital course was complicated by intracranial hypertension and cerebral oedema requiring craniectomy. Our case highlights the importance of considering NCC in the differential diagnosis of stroke in patients coming from endemic regions, especially in younger patients lacking the usual risk factors for cerebrovascular disease.

Racemose neurocysticercosis

Background:

Neurocysticercosis (NCC) is an invasive parasitic infection of the central nervous system caused by the larval stage of the tapeworm Taenia solium. The clinical manifestations of NCC depend on the parasitic load and location of infection, as well as the developmental stage of the cysticerci and host immune response, with symptoms ranging from subclinical headaches to seizures, cerebrovascular events, and life-threatening hydrocephalus. Racemose NCC represents a particularly severe variant of extraparenchymal NCC characterized by the presence of multiple confluent cysts within the subarachnoid space and is associated with increased morbidity and mortality, as well as a decreased response to treatment. Albendazole is the preferred drug for the treatment of racemose NCC due to its superior cerebrospinal fluid penetration compared to praziquantel and the ability to be used concomitantly with steroids.

Case Description:

In this report, we describe a 39-year-old man recently emigrated from Mexico with racemose NCC and hydrocephalus successfully treated with prolonged albendazole treatment, high-dose dexamethasone, and ventriculoperitoneal shunt placement for the relief of obstructive hydrocephalus.

Conclusions:

Treatment of racemose NCC represents a significant clinical challenge requiring multimodal intervention to minimize infectious- and treatment-related morbidity. We review the clinical, diagnostic, and therapeutic features relevant to the management of this aggressive form of NCC.

[Diagnostic value of CT scan in neurocysticercosis in Lome]

La cysticercose a une prévalence élevée dans les pays sub-sahariens et son diagnostic reste difficile. Cette étude a pour but de déterminer la valeur diagnostique de la tomodensitométrie dans la cysticercose cérébrale. Recrutement des patients ayant bénéficié d'une tomodensitométrie cérébrale dans l'une des circonstances suivantes: épilepsie, hypertension intracrânienne, syndrome pyramidal, détérioration mentale, ataxie locomotrice ou une diminution de l'acuité visuelle. Les critères de Del Brutto et al. avaient permis de retenir le diagnostic positif de cysticercose cérébrale. Pendant la période, 4193 patients avaient été inclus à l’étude, dont 140 cas de cysticercose cérébrale (3,3%). L’âge moyen des patients de cysticercose cérébrale était de 36 ± 14 ans, avec des extrêmes de 17 ans et 59 ans. La sensibilité et la spécificité de la tomodensitométrie dans la cysticercose cérébrale sont respectivement de 96,4% et 98,3%. La valeur prédictive positive et la valeur prédictive négative de la tomodensitométrie sont respectivement de 65,9% et 99,8%. Les aspects tomodensitométriques chez les vrais positifs sont dominés par des lésions associées, 72 cas (53,3%), suivies d'une hypodensité nodulaire arrondie unique ou multiple sans prise de contraste iodée, 17cas (12,6%). La TDM est une technique d'imagerie qui a une sensibilité et une spécificité élevées dans le diagnostic de la cysticercose cérébrale. Cependant, les autres critères de diagnostic restent utiles du fait de l'existence de nombreux cas de faux positifs à la tomodensitométrie.

Conservative management of neurocysticercosis in a patient with hematopoietic stem cell transplantation: a case report and review

Neurocysticercosis, an infection of the central nervous system with the larval stage of the cestode Taenia solium, is common in developing countries but its occurrence and management in allogeneic hematopoietic stem cell transplantation (HSCT) has not been reported previously, to our knowledge. We report the case of an immigrant female patient who underwent a matched-related allogeneic HSCT for acute lymphoblastic leukemia and was incidentally found to have a solitary viable neurocysticercosis lesion. However, despite severe immunosuppression, the size of the cyst did not increase. More importantly, restoration of the immune system did not induce significant inflammation or seizures. Subsequent follow-up demonstrated complete resolution of the neurocysticercosis lesion. Thus, in the setting of HSCT, an asymptomatic patient with a single neurocysticercosis lesion was successfully managed without the use of anthelmintics, steroids, or anti-epileptics.

Extraparenchymal (Racemose) Neurocysticercosis and Its Multitude Manifestations: A Comprehensive Review

Neurocysticercosis is an infection of the central nervous system caused by the larval form of the pork tapeworm Taenia solium. In the brain it occurs in two forms: parenchymal and extraparenchymal or racemose cysts. The clinical presentation of racemose cysts is pleomorphic, and is quite different from parenchymal cysticercosis. The clinical diagnosis of racemose cysts is quite challenging, with neuroimaging being the mainstay. However, the advent of newer brain imaging modalities has made a more accurate diagnosis possible. The primary focus of this article is racemose neurocysticercosis and its multitude manifestations, and includes a discussion of the newer diagnostic modalities and treatment options.

Neurocysticercosis (NCC) with Hydrocephalus, Optic Atrophy and Vision Loss: A Rare Presentation

Neurocysticercosis (NCC) is one of the most common parasitic infestations (Taenia solium) of central nervous system (CNS) in children. Seizures are the common presenting symptoms. Hydrocephalus and optic atrophy are rare complications which may require neurosurgical interventions. We report a case of NCC with hydrocephalus and bilateral optic atrophy associated with vision loss in a Nepalese patient who improved with anti-parasitic therapy followed by ventriculo-peritoneal (VP) shunting.

Lumbar intradural neurocysticercosis: a case report

Cysticercosis is the most common parasitic disease affecting the central nervous system. Spinal involvement is rare in neurocysticercosis, and isolated spinal involvement without evidence of cranial involvement is even rarer. We report an unusual case of neurocysticercosis with isolated spinal involvement. A 59 year-old male presented with radiating pain in the left leg. He complained of aggravating weakness and numbness in the left leg since his previous visit one month ago. Magnetic resonance imaging (MRI) revealed multiple peripheral wall-enhanced intradural cystic masses from L1 to L5. The patient underwent a total laminectomy of L4. Dissection revealed abnormal cystic masses compressing the nerve roots. The cyst was punctured, spilling clear mucoid fluid into the surgical field. The exposed cysticerci, white and mucoid, was easily removed. Patient received course of steroids and oral albendazole. The patient experienced symptomatic improvement without further neurologic deficits except for mild sensory impairment. Clinicians should include spinal neurocysticercosis in differential diagnosis of radiculopathies. Although isolated spinal neurocysticercosis is rare, it can be satisfactorily managed with surgery and medication.

A case of intradural-extramedullary form of primary spinal cysticercosis misdiagnosed as an arachnoid cyst

We describe a rare case of intradural-extramedullary primary spinal cysticercosis. A 42-year-old man visited our institute for lower back pain. He denied having consumed raw meet. Magnetic resonance (MR) images revealed an intradural pure cystic mass at the L3-L4 level. A radiologic diagnosis of spinal arachnoid cyst was established. Three years later, he complained of aggravated back pain, and follow-up MR examination showed a markedly expanded cyst, occupying the subarachnoid space from the T11 to the S1 level. L2 hemilaminectomy was performed, and a yellowish infected cyst bulged out through the dural opening. The cyst was removed en bloc. The histopathological findings of the cyst were consistent with parasitic infection. Serum enzyme-linked immunosorbent assay (ELISA) confirmed the presence of spinal cysticercosis. As there was no intracranial lesion, the final diagnosis was primary spinal cysticercosis, which is very rare. MR imaging is a sensitive diagnostic tool for detecting cystic lesions in the spine; however, it is difficult to distinguish cysticercosis from non-infectious cysts such as an arachnoid cyst without using gadolinium enhancement. Clinicians treating spinal cysts with an unusual clinical course should include cysticercosis as a differential diagnosis. We recommend contrast-enhanced MR imaging and serum ELISA in the diagnostic work-up of such cases.

Neurocysticercosis in Europe: Still a public health concern not only for imported cases

Neurocysticercosis (NCC), a parasitic disease caused by the larvae of the cestode Taenia solium, is the most frequent parasitic disease of the central nervous system (CNS) in the world and the leading cause of secondary epilepsy in Central and South America, East and South Asia, and sub-Saharan Africa. It is endemic in many low- and middle-income countries of the world. Due to increased travels and immigration, NCC may be diagnosed also in non-endemic areas. In fact, tapeworm carriers from endemic zones can transmit infection to other citizens or arrive already suffering NCC. This phenomenon, occurred first in USA during the last 30 years, has been also observed in Europe, as well as in Australia, Canada, Israel, Japan and Muslim countries of the Arab World. Actually, concerning Europe, although, in some areas only few cases have been described, nevertheless the prevalence of NCC may be considered increasing, especially in Spain and Portugal. We reviewed the literature on the burden of NCC in Europe, by a search of PubMed regarding papers from 1970 to present. We only considered on PubMed published and available papers in English, French, Italian, and Spanish, the languages understood by the authors. One hundred seventy six cases of NCC have been reported in seventeen European countries (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Netherlands, Sweden, United Kingdom, and Croatia, Norway, Switzerland). A particular epidemic situation is present in Spain and Portugal. In fact, we collected data that show, in Spain, an increasing incidence both in immigrated patients and in those which were born in certain Spanish geographical areas and, in Portugal, prevalence similar to that observed in endemic areas. Globally, it is clear that as a result of increased migrations and travels from endemic regions, NCC is becoming an emerging public health problem in high-income countries, particularly affecting communities where hygiene conditions are poor and sub-sequentially the parasite can spread from human to human through eggs even in absence of a travel to the tropics. NCC is a preventable disease, it derives that it's important to acquire a great consciousness of the epidemiology and to implement accurate surveillance systems.

Reversible dementia as a presenting manifestation of racemose neurocysticercosis

Racemose cysticercosis is a less frequent presentation of neurocysticercosis (NCC). It's presentation and management is quite different from cerebral parenchymal NCC. Diagnosis of racemose cysticercosis is based on the combination of clinical, epidemiologic, radiographic, and immunologic information. Compared with cysticercus cellulose, which most commonly presents as seizures, racemose NCC due to its extraaxial location presents with raised intracranial pressure and meningitis, and frequently requires neurosurgical intervention. Dementia as a sole presenting feature of NCC is rare. We report a case of racemose NCC with dementia as the presenting manifestation. The outcome of dementia patients with NCC seems favorable in most cases therefore a high index of suspicion for NCC should be kept especially in endemic areas.

Intramedullary spinal neurocysticercosis presenting as brown-sequard syndrome

Cysticercosis is an emerging disease in the United States. Neurocysticercosis may rarely cause disease within the spinal cord, but the occurrence of such pathology can produce debilitating symptoms for patients. We present the second report in the literature of intramedullary spinal neurocysticercosis presenting with a Brown-Sequard syndrome.

Neurocysticercosis presenting as Millard Gubler syndrome

Neurocysticercosis is a common childhood neurological illness in India. A variety of presentations have been reported in the literature, including weber syndrome. Neurocysticercosis, manifesting as Millard Gubler syndrome, have not been reported in literature. Therefore, we report a child presented to us with Millard Gubler syndrome due to pontomedullary neurocysticercosis and was treated successfully.

Primary extensive spinal subarachnoid cysticercosis

STUDY DESIGN

A case report.

OBJECTIVE

To describe a patient with a primary extensive spinal subarachnoid cysticercosis that was successfully treated with a combination of surgical removal and albendazole.

SUMMARY OF BACKGROUND DATA

Neurocysticercosis (NCC) is the most common parasitic infection of the central nervous system. It is mostly intracranial, but primary cysticercosis, although rare, can occur in the spinal canal. Neurological morbidity can occur if NCC is not properly treated; therefore, NCC should be considered as a lesion of primary nerve compression, which occurs within spinal canal as well as cranial cavity.

METHODS

A 48-year-old male patient presented with an 18-month history of progressive lower limb weakness and urinary incontinence. Contrast-enhanced lumbar magnetic resonance image showed multiple intradural and extramedullary masses and cysts from T12 to S1. A cervicothoracic magnetic resonance image revealed whole cervical and upper thoracic involvement. The patient was treated with a combination of surgical removal and orally administered albendazole.

RESULTS

A histopathological examination confirmed cysticercosis. After the treatment, cysticercosis had disappeared on follow-up. The patient's motor weakness in the lower limbs and urinary function were improved.

CONCLUSION

Spinal subarachnoid cysticercosis can occur via direct hematogenous dissemination from a gastrointestinal tract. The primary spinal cysticercosis can be dropped distantly in the spinal cavity by cerebrospinal fluid circulation like intracranial cysticercosis, and extensive spinal subarachnoid cysticercosis can be successfully treated with a combination of surgical removal and cysticidal drugs.

Reduced diffusion in neurocysticercosis: circumstances of appearance and possible natural history implications

BACKGROUND AND PURPOSE

Few studies discuss DWI findings in patients with NCC, and their conclusions are variable and contradictory. The aim of our study was to describe DWI findings of a cohort of patients with NCC, emphasizing the frequency of reduced diffusion.

MATERIALS AND METHODS

This retrospective study included 48 patients with NCC. Two neuroradiologists analyzed MR images regarding location, number, and stage of NCC lesions. On the basis of visual analysis, they defined, by consensus, the presence of high signal within NCC lesions on DWI and measured their ADC values when feasible.

RESULTS

The total number of lesions was 342: parenchymal (263), subarachnoid (65), and intraventricular (14); 83 were DWI hyperintense. The first pattern was a small eccentric hyperintense dot/curvilinear structure on DWI (representing the scolex) noted in intraparenchymal lesions in vesicular (41 lesions, 29%) and colloidal vesicular (18 lesions, 19%) stages, in 14 (22%) subarachnoid lesions, and 2 (14%) intraventricular lesions; rADC calculations were hampered by the intrinsic small dimensions of this finding. The second pattern was the presence of total/subtotal DWI hyperintensity in intraparenchymal lesions, 5 in the colloidal vesicular stage (5%) and 1 in the granular nodular phase (3%). Two subarachnoid lesions also showed the same presentation; in this second pattern, reduced diffusion was present in different degrees, measured by rADC calculations.

CONCLUSIONS

DWI may identify the scolex, increasing diagnostic confidence for NCC. Total/subtotal DWI hyperintensity, related to the stage of the lesion, though uncommon, allows including NCC as a consideration in the differential diagnosis of lesions with reduced diffusion and ring enhancement.

Neurocysticercosis in pregnancy: not just another headache

Infection with pork tapeworm, or Taenia solium, affects approximately 50 million people worldwide. The most important and potentially devastating form of the infestation, neurocysticercosis, occurs when the parasite invades the central nervous system. There has been a significant increase in the number of cases in the United States due to immigration from endemic areas. This case study of a pregnant woman in the 35th week of gestation exemplifies the serious consequences of this infection in pregnancy, and discusses an evidence-based approach to the diagnosis, treatment and eradication of this preventable disease.

Spinal cysticercosis mimicking a tumor in a pediatric patient

Parasitic infections of the central nervous system (CNS) occur mostly in underdeveloped regions of the world. Neurocysticercosis (NC) occurs when the larval form of the T. solium tapeworm invades the CNS. Spinal cysticercosis is an extremely rare type of NC and occurs when the cyst occupies the subarachnoid space of the spinal column. Previous cases have been successfully treated through both surgical and medical means. The current case describes the symptoms, diagnosis, and treatment of a patient with this extremely uncommon manifestation of neurocysticercosis.

Incidental consequences of antihelmintic treatment in the central nervous system

BACKGROUND

Neurocysticercosis (NCC) is the most common parasitic infection in the central nervous system and the most common cause of acquired neurological symptoms in young adults living in developing countries. Many "asymptomatic" patients begin experiencing neurological symptoms after the use of antiparasitic drugs for gastrointestinal treatment. Patients who are previously diagnosed with NCC require special care during cysticidal treatment because of the inflammatory effects caused by the interaction between the drug, the parasite, and the host.

CASE DESCRIPTION

Of a series of 46 cases, we selected five patients with a history of being "asymptomatic" and who began experiencing neurologic symptoms after the use of albendazole, which led to a diagnosis of cysticercosis. Another case of the patient, who already had been diagnosed of ventricular cysticercosis, was given a drug treatment without consulting the neurosurgeon and had a fatal outcome attributable to secondary meningoencephalitis.

RESULTS

In the first five cases, with new neurological symptoms after antihelmintic treatment, the self-prescription is remarkable. The symptoms appear between the third and fifth day of treatment. All of them had a clinical course without complications. Only two cases minimally invasive techniques were required. The case who had been already diagnosed developed meningoencephalitis and died after eight days of antihelmintic treatment.

CONCLUSIONS

Anthelminthic drug treatment requires tailor-based prescription considering risk-benefit ratio with the drug-parasite-host interaction in mind. Treatment is not harmless so patients have to be closely watched. In select cases, medical treatment cannot replace surgical procedures, which can be the primary approach with drug treatment as a complement.

Confirmation and follow-up of neurocysticercosis by real-time PCR in cerebrospinal fluid samples of patients living in France

Neurocysticercosis diagnosis is based on a combination of clinical, epidemiological, radiological, and immunological findings. We describe a real-time PCR assay for the confirmation of neurocysticercosis diagnosis in cerebrospinal fluid. The assay, tested on samples from nine patients living in France and diagnosed with neurocysticercosis, had a detection rate of 83.3% and 100% specificity.

Clinical manifestations associated with neurocysticercosis: a systematic review

BACKGROUND

The clinical manifestations of neurocysticercosis (NCC) are poorly understood. This systematic review aims to estimate the frequencies of different manifestations, complications and disabilities associated with NCC.

METHODS

A systematic search of the literature published from January 1, 1990, to June 1, 2008, in 24 different electronic databases and 8 languages was conducted. Meta-analyses were conducted when appropriate.

RESULTS

A total of 1569 documents were identified, and 21 included in the analysis. Among patients seen in neurology clinics, seizures/epilepsy were the most common manifestations (78.8%, 95%CI: 65.1%-89.7%) followed by headaches (37.9%, 95%CI: 23.3%-53.7%), focal deficits (16.0%, 95%CI: 9.7%-23.6%) and signs of increased intracranial pressure (11.7%, 95%CI: 6.0%-18.9%). All other manifestations occurred in less than 10% of symptomatic NCC patients. Only four studies reported on the mortality rate of NCC.

CONCLUSIONS

NCC is a pleomorphic disease linked to a range of manifestations. Although definitions of manifestations were very rarely provided, and varied from study to study, the proportion of NCC cases with seizures/epilepsy and the proportion of headaches were consistent across studies. These estimates are only applicable to patients who are ill enough to seek care in neurology clinics and likely over estimate the frequency of manifestations among all NCC cases.

A rare gigantic solitary cysticercosis pseudotumour of the neck

Cysticercosis is one of the ancient parasitic infections and endemic in many parts of the developing world. Humans acquire cysticercosis when they ingest pork tapeworm eggs either through faecal-oral route by eating faecally contaminated food or by auto infection.

The clinical picture largely depends on the location of larval encystment. Neurocysticercosis is the most common form of presentation. Solitary extra neural lesions are quite rare and fairly small in size.

We present a very unique case of 56 year old Malawian female with a very rare, long standing gigantic solitary cysticercosis pseudo tumour of the neck. By far, there is no documented report on incorrigible cysticercosis lesion with such a sheer size.

Solitary extraneural cysticercosis lesions may mimic other soft tissue masses; therefore it is important for clinicians working in endemic regions to consider cysticercosis as a differential diagnosis when evaluating patients with soft tissue lesions.

Cysticercal encephalitis with cortical blindness

The authors report a 6-year-old boy, who had presented with low-grade fever, altered sensorium, headache and seizure for 5 days. On examination, he had features of raised intracranial pressure with left VI cranial-nerve palsy and bilateral extensor plantar response. CT scan showed multiple calcifications in cerebral cortex. MRI cranium showed multiple cysts involving whole of the brain. He was diagnosed as having cysticercal encephalitis, based on immunological and imaging study. He was managed with 20% mannitol, phenytoin and albendazole, and regained consciousness 7 days later, but had residual neurological deficit as left-lower-limb monoparesis and visual acuity of just projection of rays (PR+) and perception of light (PL+).

Resolution of acute hydrocephalus and migration of neurocysticercosis cyst with external ventricular drainage

Neurocysticercosis is endemic in the developing world, but is becoming more common in the US due to immigration. A 24-year-old man presented with acute hydrocephalus and headaches, nausea, and vomiting. Head CT revealed a 3rd ventricular cyst and immunological studies were suggestive of neurocysticercosis. EVD placement resulted in migration of the cyst interiorly and superiorly with return of normal CSF flow by MRI and resolution of symptoms. Review of this condition is important given increasing incidence in the United States.

Recurrent primary spinal subarachnoid neurocysticercosis

STUDY DESIGN

Case description.

OBJECTIVE

To describe a patient with a recurrent primary spinal subarachnoid neurocysticercosis (NCC) that was successfully treated with surgical decompression and medical therapy at our center.

SUMMARY OF BACKGROUND DATA

Spinal subarachnoid NCC is thought to be the secondary result from larval migration through the ventricular system into the spinal subarachnoid space. However, this entity can develop as a primary infection through blood stream or direct larval migration. It can result in high recurrence and severe neurologic morbidity if it is not treated in an appropriate manner.

METHODS

A 50-year-old woman with treatment history of spinal NCC presented with back pain and radicular pain. The lumbar magnetic resonance imaging showed a cystic lesion with septation and slight rim enhancement after gadolinium administration at the L4-S1 area. We performed surgical removal of this lesion and postoperative medical therapy for complete eradication of the parasite.

RESULTS

The histopathology was diagnostic for a cysticercal cyst. Adjuvant medical therapy with albendazole was administered for 30 days after surgery. The patient remained symptom-free for 1 year after surgery without any evidence of recurrence.

CONCLUSION

We report a rare case of recurrent primary spinal subarachnoid NCC at L4-S1 area. In cases of primary spinal subarachnoid NCC can be treated by adequate combined approach with surgery and medical therapy. Spinal subarachnoid NCC should be added to the differential diagnosis of primary spinal intradural cysts, because this lesion can occur primarily.

Selection of high affinity peptide ligands for detection of circulating antibodies in neurocysticercosis

Neurocysticercosis (NC), caused by Taenia solium, is the most common infection caused by helminthes of the human central nervous system. In this study, a random peptide phage display library was used to isolate peptide ligands as potential markers for neurocysticercosis diagnosis, because occurrence of cross-reactions with other helminthes species in the current used markers. We selected different peptides using IgG purified from pooled sera of neurocysticercosis patients. To investigate the diagnostic potential of recombinant peptides, we have tested different panels of serum samples by Phage-ELISA, and 10 phage clones strongly bound to the anti-T. solium IgGs in NC sera, with an accuracy range from 84.2% to 95%. The phage clones, NC(4)1 and NC(2)8, presented the highest sensitivity and specificity (100%), respectively, and most important, some phage clones did not react with patients' sera from Echinococcus granulosus infected patients. The validation with a competitive ELISA assay demonstrated that the selected phages could mimic T. solium epitopes and bind specifically to the pool of NC sera. Finally, the two recombinant antigens may become potential biomarkers for serodiagnosis of NC, and the Phage-ELISA demonstrated to be a very good assay, being reproducible, simple, fast, and low-cost due to its production through Escherichia coli culture, allowing a high throughput screening of NC.

Intramedullary cysticercosis

Intramedullary cysticercosis is a rare form of cysticercosis in the central nervous system. A 55-year-old woman was admitted with low back pain, urinary incontinence, paraparesis and sensory deficit. Her MRI showed a well-defined intramedullary cystic lesion at T7 vertebral level with peripheral enhancement on contrast. She underwent a T7-T8 laminectomy and excision of the lesion. Histopathology revealed the lesion to be a cysticercus granuloma. A postoperative course of albendazole was given. The patient showed significant neurological improvement at follow-up.

Do helminths cause epilepsy?

Both helminthiases and epilepsy occur globally, and are particularly prevalent in developing regions of the world. Studies have suggested an association between epilepsy and helminth infection, but a causal relationship is not established in many helminths, except perhaps with neurocysticercosis. We review the available literature on the global burden of helminths, and the epidemiological evidence linking helminths to epilepsy. We discuss possible routes that helminths affect the central nervous system (CNS) of humans and the immunological response to helminth infection in the CNS, looking at possible mechanisms of epileptogenesis. Finally, we discuss the current gaps in knowledge about the interaction between helminths and epilepsy.

Transventricular neuroendoscopic excision of giant racemose subarachnoid cysticercosis

PURPOSE

Subarachnoid cysticercosis, an uncommon form of neurocysticercosis, can occasionally grow to giant size causing mass effect and obstructive hydrocephalus. These often require surgical excision to relieve the mass effect and re-establish the cerebrospinal fluid (CSF) pathways.

CLINICAL PRESENTATION

The authors report a rare case of giant anterior interhemispheric racemose cysticercosis with extension to the region of septum pellucidum causing obstructive hydrocephalus.

INTERVENTION

Due to the proximity of the cysts to the dilated ventricular system, a frontal transventricular endoscopic approach was preferred over a conventional microsurgical or endoscopic-assisted microsurgical approach. Most of the cysts could be successfully resected from the region of septum pellucidum and the anterior interhemisphere. The patient did not require a CSF diversion procedure in the postoperative period.

CONCLUSION

Depending on the location and nature of the lesion, a transfrontal transventricular endoscopic approach can be successfully utilized to approach lesions in the anterior interhemispheric region.

Saline extract of Taenia saginata metacestodes as an alternative antigen for the immunodiagnosis of neurocysticercosis in human cerebrospinal fluid

The aim of the present research was to test the application of Taenia saginata metacestodes as an alternative antigen for use in enzyme-linked immunosorbent assay (ELISA) and Western Blotting (WB) tests compared with the use of metacestodes antigen of Taenia solium in cerebrospinal fluid (CSF) samples. The samples were obtained from 35 patients with definitive neurocysticercosis (NCC)-group 1-and 44 patients with other neurological disorders (control)-group 2. The sensitivity and specificity of ELISA, using antigen obtained from T. solium, applied to the patients of group 1 yielded results of 100%. When the tests were conducted using T. saginata metacestodes, results were 100% and 93.2%, respectively. The 47-52-, 64-68-, and 70-kDa antigens showed high frequencies in CSF samples from patients with NCC when WB was conducted with both antigens. The results indicate that T. saginata metacestodes can be used as an alternative antigen for the diagnosis of human NCC in CSF samples.